Provider Demographics
NPI:1144859703
Name:ORNQUIST, GENA RUTH (LPC)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:RUTH
Last Name:ORNQUIST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JOSSELIN LN
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7110
Mailing Address - Country:US
Mailing Address - Phone:907-745-2060
Mailing Address - Fax:
Practice Address - Street 1:1000 JOSSELIN LN
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7110
Practice Address - Country:US
Practice Address - Phone:907-745-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional